Ultrasound-Guided Cortisone Injections for Shoulder Bursitis

 

Introduction

Shoulder bursitis is a common condition characterised by inflammation of the bursa, a fluid-filled sac that reduces friction between tissues in the shoulder joint. It can cause pain, stiffness, and restricted movement, making everyday activities such as reaching, lifting, or even sleeping difficult.

At Alton Pain Clinic, we provide a range of treatment options for shoulder bursitis, including ultrasound-guided cortisone injections. These injections are used selectively to manage pain and inflammation. This blog will provide a comprehensive overview of shoulder bursitis, including its anatomy, pathology, causes, symptoms, diagnosis, treatment options, and the role of cortisone injections in its management.



Anatomy of the Shoulder Bursa

The shoulder is a highly mobile joint consisting of bones, muscles, tendons, ligaments, and bursae that work together to enable a wide range of motion.

A bursa is a small, fluid-filled sac that acts as a cushion to reduce friction between bones, tendons, and muscles. The shoulder contains several bursae, with the subacromial bursa being the most commonly affected in bursitis.

Key Structures in the Shoulder

  • Humerus (Upper Arm Bone) – Connects with the scapula to form the shoulder joint.
  • Scapula (Shoulder Blade) – Provides attachment points for muscles and ligaments.
  • Clavicle (Collarbone) – Connects the shoulder to the sternum.
  • Rotator Cuff Muscles and Tendons – Stabilise the shoulder joint and allow movement.
  • Acromion – The bony projection on the scapula that forms part of the shoulder’s structure.
  • Bursa – Reduces friction between tendons and bones.

When the bursa becomes irritated or inflamed, it leads to shoulder bursitis, causing pain and restricted mobility.

Pathology of Shoulder Bursitis

Shoulder bursitis occurs due to excessive friction, repetitive movements, or direct trauma, leading to inflammation of the bursa. This results in increased fluid accumulation within the bursa, causing pain, swelling, and restricted movement.

There are two main types of shoulder bursitis:

  1. Acute Shoulder Bursitis – Develops suddenly, often due to direct trauma, infection, or excessive strain.
  2. Chronic Shoulder Bursitis – Develops gradually due to repetitive stress or underlying conditions such as arthritis.

With prolonged irritation, the bursa may undergo fibrotic changes, leading to persistent symptoms.

Causes and Risk Factors

Several factors contribute to the development of shoulder bursitis.

Intrinsic Factors

  • Ageing – Increased risk due to natural wear and tear of the shoulder structures.
  • Shoulder Impingement Syndrome – Compression of the subacromial bursa during arm movements.
  • Muscle Imbalances – Weakness or tightness in the rotator cuff muscles affecting shoulder mechanics.
  • Arthritis – Conditions such as osteoarthritis or rheumatoid arthritis may contribute to inflammation.

Extrinsic Factors

  • Repetitive Overhead Activities – Common in athletes (e.g., swimmers, tennis players) and individuals with jobs involving overhead work.
  • Direct Trauma – Falls or direct impact on the shoulder can inflame the bursa.
  • Poor Posture – Forward head posture or rounded shoulders can increase stress on the bursa.

Symptoms of Shoulder Bursitis

The symptoms of shoulder bursitis can vary in intensity but often include:

  • Pain – A dull, aching pain in the shoulder, particularly when lifting the arm.
  • Tenderness – Pain when pressing over the affected bursa.
  • Stiffness – Reduced range of motion, making it difficult to raise the arm.
  • Swelling – Inflammation of the bursa leading to visible or palpable swelling.
  • Pain at Night – Discomfort when lying on the affected shoulder.

Symptoms may worsen with repetitive movements or prolonged activity.

Diagnosis of Shoulder Bursitis

Diagnosing shoulder bursitis involves:

  1. Medical History – Evaluating symptoms, activity levels, and potential triggers.
  2. Physical Examination – Assessing pain, range of motion, and tenderness.
  3. Ultrasound Imaging – Provides real-time visualisation of bursal inflammation and fluid accumulation.

At Alton Pain Clinic, ultrasound imaging plays a crucial role in confirming the diagnosis and guiding treatment decisions.

Management of Shoulder Bursitis

Treatment aims to reduce pain and inflammation while restoring function.

Conservative Management

  • Activity Modification – Avoiding repetitive overhead movements.

Interventional Management

  • Ultrasound-Guided Cortisone Injections – Used selectively for persistent pain and inflammation.

Ultrasound-Guided Cortisone Injections for Shoulder Bursitis

Cortisone injections are a type of corticosteroid treatment used to help manage inflammation and pain associated with shoulder bursitis. These injections are administered under ultrasound guidance, ensuring precision and accuracy.

Mechanism of Action

Cortisone injections work by:

  • Reducing Inflammation – Corticosteroids inhibit inflammatory chemicals, reducing swelling and discomfort.
  • Suppressing Immune Response – Decreasing excessive immune activity that contributes to bursal irritation.
  • Modulating Nerve Activity – Temporarily reducing pain signals from the affected area.

Ultrasound guidance ensures the injection is delivered precisely into the inflamed bursa, enhancing effectiveness while minimising potential risks.

Benefits of Ultrasound-Guided Cortisone Injections

  • Accurate Targeting – Ensures precise delivery of cortisone into the inflamed bursa.
  • Minimised Risk – Reduces the likelihood of unnecessary tissue damage.
  • Real-Time Visualisation – Enhances safety and effectiveness.

At Alton Pain Clinic, we use ultrasound imaging to optimise the accuracy of cortisone injections.

Considerations and Precautions

While cortisone injections can provide temporary relief, they are used selectively. Excessive corticosteroid use may lead to potential side effects, including tendon weakening. Therefore, these injections are typically reserved for cases where pain significantly affects daily activities and conservative treatments have not provided sufficient relief.

Conclusion

Shoulder bursitis can significantly impact mobility and quality of life. While conservative treatments often help manage symptoms, interventional options such as ultrasound-guided cortisone injections may be considered in specific cases.

At Alton Pain Clinic, we offer advanced, precision-guided treatments to help manage shoulder bursitis effectively. If you are experiencing persistent shoulder pain, a thorough assessment can help determine the most suitable course of action.

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